I SHOWED YESTERDAY THAT AMERICAN RNs ARE BEING FORCED TO LEAVE BY ADVERSE WORKING CONDITIONS JUST AS ARE TEACHERS NOW. BELOW YOU SEE WHY-----TAKING LABOR AS CHEAP AS IT WILL GO.NEO-LIBERALS AND NEO-CONS---WHY ARE YOUR NATIONAL LABOR LEADERS SUPPORTING THEM?I want to look locally but what I am sharing is happening all over the US. Again, this is not anti-immigrant -----we love and protect immigrant rights----it shows how US neo-liberal/neo-con global policies are bad for everyone. Foreign workers do not want to leave their homes to come to the US for the most part. They want work at home. They are often lied to as to what their lives will be once they come to work in the US under the guise of 'shortages in skilled workers'. So, this exposes bad policy for US workers and those immigrant workers being brought to the US. Time after time I hear these immigrant workers say they want to simply go back home because what was offered looks nothing like they were promised. Indeed, the only purpose of these international staffing schemes is to bring labor to the US to be exploited as cheap labor. With unemployment at 36% in the US and large percentages with professional degrees now taking poverty jobs we all know the shortage of workers in the US is tied to yesterday's blog----burn out from bad work conditions----global corporates want US workers to quit.Below you see the US corporation whose operations identify, train, and bring back immigrant labor to the US all while pretending they are in that nation training people to serve in their own countries. JHPIEGO is Johns Hopkins International and they are given hundreds of miillions of dollars in Federal funding to go overseas and train people to work as health care workers and teachers. Now, if you notice Baltimore and Maryland has super-sized its immigrant labor in health care and teaching......and many work with any number of Johns Hopkins health care corporations. As the article below states there is very little accountability in this program and there is no documentation of JHPIEGO's accomplishments for the overseas communities---the article says not many people seem involved. Well, I'm here today using deductive reasoning to say that this operation is more about identifying, training, and bringing immigrants back to the US to be exploited.A few years ago national newspapers had articles of nations around the world decrying the US taking these citizens to the US when they are needed at home. The problem----there is no money in those nations to hire these people trained. So, it is all a scam.Again, we are not against immigrants coming to the US. We are against how it is being done and the goal behind it. A time of great economic distress and unemployment in the US is not a time for a flood of immigrants. The article from the White House below says that America was built on immigrant labor. Well, that was when America was empty of people and Westward expansion created genocide for indigent people. IT WAS BAD THEN AND IT IS EXTREMELY BAD NOW. Who is supporting this Senate Immigration Reform knowing all of this is the goal? National Labor Union leaders, justice organizations like NAACP, and neo-liberal and neo-con pols. As I shared yesterday, most Hispanic leaders know this IMMIGRATION POLICY IS bad news.'Yet the tallies of people involved in JHPIEGO's endeavors are sometimes relatively small for PEPFAR, which measures success by the numbers.In at least one case, Dowding said he felt that reported numbers didn't accurately reflect the quality of JHPIEGO's program'.Jhpiego was actively working in the following African countries: Angola, Benin, Botswana, Burkina Faso, Cameroon, Chad, Côte d'Ivoire, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mozambique, Namibia, Nigeria, Rwanda, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe[3]Asia, Near East and Europe Latin America and the CaribbeanI am not saying that this organization is not helping communities overseas----I am saying that it is bringing back immigrant labor from these countries trained to work in health care and teaching etc.JHPIEGO This Johns Hopkins-affiliated nonprofit trains health care providers to give care abroad By Devin Varsalona 12:00 am, December 13, 2006 Updated: 12:19 pm, May 19, 2014 CommentE-mailPrintJHPIEGO (its name is not an acronym), a nonprofit health organization affiliated with The Johns Hopkins University, works worldwide to "train trainers" — whether they are hospital employees or African village laymen.JHPIEGO draws on resources from Johns Hopkins' schools of Public Health, Medicine and Nursing, but doesn't offer medical treatment or family services. The organization trains people overseas to do that instead, and mainly uses local medical practitioners and trainers to run its programs."Our focus is on establishing the system," said Sam Dowding, acting director of JHPIEGO's Center of Excellence on HIV/AIDS. "We work in institutions where we train the trainers, so in 5 years, 10 years, it continues to be self-sustained."The organization's funding largely comes from the federal government, which has backed the organization since its first day in operation.In 2005, the Presidents Emergency Plan for AIDS Relief, a five-year, $15 billion initiative to fight AIDS abroad, granted the organization $8.2 million for its efforts in Côte d'Ivoire, Ethiopia, Mozambique, South Africa, Tanzania and Zambia. The funding accounted for more than a fifth of JHPIEGO's $37.5 million program expenditures and built on its work in more than 90 countries worldwide.But at least one of JHPIEGO's programs has been debated in international circles and was not supported by PEPFAR.Working history with U.S. government For more than 30 years, JHPIEGO has been working with the U.S. Agency for International Development to improve health care services for women and families in developing countries.It was founded in 1973 to implement a five-year USAID grant to train obstetricians and gynecologists. After the grant's extension, JHPIEGO expanded its global presence through partnerships with USAID, then with private foundations and other international health organizations.About 25 years after its inception, JHPIEGO made its first inroads into HIV/AIDS relief as part of a consortium of organizations working in West Africa. By 2002, it had entered a five-year partnership with the U.S. Centers for Disease Control and Prevention called the University Technical Assistance Project.The project, now fully funded by PEPFAR, includes nine other U.S. research universities and provides the CDC with country-specific assistance for HIV/AIDS relief programs. Infection prevention, antiretroviral treatment, counseling and testing services are among the needs addressed through the program.Through their partnership, the CDC funds 70 percent of expenditures for JHPIEGO's Center of Excellence on HIV/AIDS, established in 2004. That commitment was worth more than $10 million in fiscal 2005 across several countries, including the six of PEPFAR's 15 focus countries in which JHPIEGO operates.PEPFAR programsAccording to Dowding, JHPIEGO implements a step-by-step learning method in its field training programs.Local health care providers become "qualified clinical trainers" upon completing one or two courses and after conducting their own sessions under review. Through additional coursework, they move on to "advanced trainer," and then may be selected to complete coursework for "master trainer" status. At the peak levels, they help instruct those under them.While much of its work is carried out through established institutions, such as hospitals, health centers and ministries of health, the organization also has addressed culturally specific needs. In Mozambique, for example, JHPIEGO was awarded PEPFAR funds in 2005 to provide training for a community-based method of HIV testing."The Mozambique government recently agreed to an initiative to try to come up with a way of testing every person in the country," Dowding said. "They asked us how we'd do it. We said we'd train lay counselors to go from home to home instead of relying on individuals to come into health centers."Federal documents obtained by the Center for Public Integrity through a Freedom of Information Act request show that JHPIEGO has worked largely in institutional settings. It has implemented programs in Zambian military hospitals to prevent mother-to-child disease transmission, educated injection and bio-safety trainers in Mozambique and has worked closely with various Ministries of Health to develop training guidelines, like Ethiopia's National Infection Prevention Guidelines.

Yet the tallies of people involved in JHPIEGO's endeavors are sometimes relatively small for PEPFAR, which measures success by the numbers.In his 2003 State of the Union address in which he introduced PEPFAR, President George W. Bush called it a "work of mercy beyond all current international efforts to help the people of Africa" that would prevent seven million new infections, treat at least 2 million infected individuals and provide care for millions of people affected by HIV/AIDS.Since then, those target numbers have been calculated through the combined efforts implemented by all contractors, including JHPIEGO. Although JHPIEGO and USAID collaborate on their goals, Dowding shared concern with other organizations over a pressure to produce numbers."We've had to change training methodology considerably," Dowding said, referring to a program in South Africa. "We're not one to do training programs with 60 people in a room over two days of lectures. That's not what JHPIEGO prefers, but that's how we have to [work] because of the challenges and resources available."In at least one case, Dowding said he felt that reported numbers didn't accurately reflect the quality of JHPIEGO's program.In 2005, JHPIEGO and Family Health International — which Dowding called a "major competitor" — both worked on an effort to train HIV counselors and testers in Ethiopia. While JHPIEGO trained 181 individuals in military and civilian hospitals, FHI educated 1,170 people in health centers and communities."We report on the numbers of hospitals [in Ethiopia], which doesn't really reflect our work," Dowding said. "You're not going to be satisfied in doing it in a fairly shallow way; we want to make sure we're doing a quality job."Debate over male circumcisionAnother issue JHPIEGO has raised with PEPFAR remains controversial in international health circles.In the late 1980s, researchers in Africa began to notice that HIV infection rates were much higher in areas where male circumcisions were not performed due to tribal or regional culture, according to a San Francisco Chronicle report on the practice. Circumcision removes the foreskin, which is filled with white blood cells that AIDS researchers say allow HIV additional access to the bloodstream.JHPIEGO has had success with a program advocating male circumcision in Zambia under separate USAID funding. It has tried pushing for PEPFAR to support a similar initiative, but to no avail. "We continue to try to get policymakers to see that HIV relief … [involves] a wide range of issues," Dowding said.Along with JHPIEGO, other international health organizations have issued a call to make inexpensive male circumcisions safe and widely available, saying that doing so would help the infection rate to fall. At the 2006 International AIDS Conference, former President Bill Clinton suggested that he would endorse the practice if studies prove it to be effective.Yet at the same conference, where JHPIEGO presented its results from Zambia, others pointed out religious and cultural stigmas against male circumcision, as well as noting that there could be a backlash.The Canadian Press reported that Catherine Hankins, chief scientific adviser for the United Nations AIDS program, noted there that circumcised men are looked down upon in some African cultures. Other men might think that circumcision would take the place of wearing a condom, others argued.PEPFAR hasn't yet included the practice in its prevention strategy, but it may be moving towards funding the practice. Its second annual report to Congress, released in February 2006, mentions the convening of a Scientific Advisory Board to review data and draft recommendations about male circumcision. The report also says that 2006 funding in Kenya has been appropriated to explore the acceptability and feasibility of male circumcision in the future.____________________________________________Imported Care: Recruiting Foreign Nurses To U.S. Health Care Facilities

Abstract As U.S. health care facilities struggle to fill current registered nurse staffing vacancies, a more critical nurse undersupply is predicted over the next twenty years. In response, many institutions are doubling their efforts to attract and retain nurses. To that end, foreign nurses are increasingly being sought, creating a lucrative business for new recruiting agencies both at home and abroad. This paper examines past and current foreign nurse use as a response to nurse shortages and its implications for domestic and global nurse workforce policies. Importing nurses is likely to remain a viable and lucrative strategy for plugging holes in the U.S. nurse workforce.Within the first two decades of the twenty-first century, the U.S. population is projected to grow at least 18 percent, and the population age sixty-five and older will increase at three times that rate. ﻿Meeting the demand for registered nurses (RNs) that an aging population will require will be a challenge.﻿ The U.S. Department of Health and Human Services (HHS) estimated that the United States was weathering a shortfall of 111,000 full-time-equivalent (FTE) RNs in 2000 and projected that this figure will grow to 275,000 by 2010.2 That imbalance will nearly triple in the subsequent decade, reaching a shortfall of 800,000 FTE RNs by 2020. This looming crisis has spurred public- and private-sector health care leaders to advocate for serious and creative solutions to bolster RN supply. U.S. health care facilities, which confront the nursing shortage twenty-four hours a day, are adopting a host of strategies to attract nurses to fill current nursing vacancies and to stave off future shortfalls. Among these strategies is the recruitment and employment of foreign nurses. This is not a new phenomenon; U.S. health care institutions have done it for more than fifty years. What differs today, however, is the marked expansion of organized international nurse recruitment; the growth of private, for-profit agencies to do this work; and an increasing number of countries sending nurses abroad. Many of these countries are poorly positioned to surrender large numbers of qualified nursing staff.The consequences for these sending countries have become the focal point of growing international debate that is rising to the highest policy-making levels, although with little resolution.Overshadowed by that debate, the consequences for nurse migrants and their workplaces, for quality of care and patient outcomes, and for workforce planning efforts have received little attention. Meanwhile, the United States, while not the world’s largest recruiter of foreign nurses, is recruiting greater numbers than it ever did in the past and is poised to greatly increase those efforts. We argue that the demand-driven U.S. nurse shortage represents a strong migratory “pull” factor for nurses throughout the world, which has stimulated the growth of for-profit organizations to serve as brokers to ease the way for nurses to emigrate. This is occurring, however, in the absence of a careful examination of the implications for nurse recruits and the impact on the health care delivery systems that both send and receive them. The Foreign Nurse Pool: Then And Now During the past fifty years the United States has regularly imported nurses to ease its nurse shortages. Although the proportion of foreign nurses has never exceeded 5 percent of the U.S. nurse workforce, that figure is now slowly rising. The Philippines has dominated the nurse migration pipeline to the United States and to other recruiting countries. Indeed, until the mid-1980s Filipino nurses represented 75 percent of all foreign nurses in the U.S. nurse workforce. Their representation dropped to 43 percent by 2000 as more countries began sending nurses abroad. After slowing in the second half of the 1990s, nurse migration to the United States increased, with the Philippines still leading the way for an even larger group of countries. In 1995 nearly 10,000 foreign nurses received their U.S. RN licenses, representing almost 10 percent of all newly licensed RNs in that year. By 1998 that proportion fell by nearly half, as the number of new foreign nurses entering the U.S. workforce fell more steeply than the number of new U.S. RNs (Exhibit 1⇓). After 1998 the foreign nurse proportion steadily grew, topping 14 percent in 2003. The growth since 2001 is particularly noteworthy because it occurred as the number of U.S.-trained RNs rose, reversing declines since 1995. EXHIBIT 1 Percentage Of Newly Licensed Registered Nurses (RNs) In The United States Who Are Foreign Educated, 1995–2003 Filipino nurses represented more than half of the foreign graduates taking the U.S. licensure exam in 2001 (Exhibit 2⇓). Together, nurses from Canada, the United Kingdom, India, Korea, and Nigeria contributed about half that rate. The remainder were from thirty-five countries that were not found among the 1997 cohort.EXHIBIT 2 Percentage Of First-Time, Foreign-Trained Registered Nurse (RN) Candidates For U.S. Licensure Examination, By Top Six Exporting Countries, 1997–2001 Upon coming to the United States, foreign nurses are employed in an increasingly diverse array of settings (Exhibit 3⇓). Like their U.S. counterparts, the percentage of foreign nurses working in hospitals has steadily declined over the past decade, from 79.9 percent to 71.5 percent, as organizational and financing reforms have encouraged movement of patient care out of hospitals. At the same time, their numbers in public/community health and ambulatory settings have grown, also mirroring those of U.S.-trained nurses. Unlike domestic nurses, however, foreign nurse representation in nursing homes has risen from 7.4 percent to 9.3 percent.14EXHIBIT 3 Distribution Of U.S.-Trained And Foreign-Trained Nurses, By Setting, 1992 And 2000The Impact Of Migration: Home And Abroad Nurses are enticed to leave their home countries by promises of better pay and working conditions; improved learning and practice opportunities; and free travel, licensure, and room and board. Primarily female, nurses often have opportunities for wages unequaled in their own countries and thus become the means for substantial remittances. In 2004 the U.S. Department of Labor reported median annual earnings for RNs in 2002 as $48,090; in hospitals and nursing homes where foreign nurses worked, earnings averaged $49,190 and $43,850, respectively. These figures contrast sharply with the $2,000–$2,400 annual salaries paid to nurses in the Philippines in 2002. Shifting the nurse supply. As the United States and other developed countries look to international nurse recruits to balance their national nurse supply and demand, however, sending countries are increasingly questioning the impact on their own health care systems. In perhaps the most striking example, the Wall Street Journal noted that the growing number of Filipino nurses migrating abroad is creating a domestic shortage and beginning to strain the Philippines’ health care system rather than providing an economic benefit as it had in previous years. A growing number of other countries are facing a situation similar to that of the Philippines. New offshore recruiting initiatives by developed countries have targeted English-speaking nurses from sub-Saharan Africa, Southeast Asia, and the Caribbean. Experienced nurses, especially those with specialty skills in surgical, neonatal, or critical care nursing, are in particularly high demand. While the United States has only recently begun active nurse recruitment in South Africa, former Commonwealth countries such as the United Kingdom and Australia have already drawn large numbers of nurses from this area of the world. Between 1998 and 2002 the United Kingdom alone recruited 5,259 nurses from South Africa, along with 1,166 from Nigeria, 1,128 from Zimbabwe, and 449 from Ghana. The accelerated recruitment of experienced African nurses is straining an already fragile health care infrastructure in many African countries, which have been battered by AIDS and deprived of resources because of economic and political upheaval. Sixteen African countries have an average of 100 nurses per 100,000 population; ten countries average fifty nurses per 100,000; nine report twenty per 100,000; and three have fewer than ten nurses per 100,000. In stark contrast, U.S. and U.K. ratios are 782 and 847 per 100,000, respectively. In 2000 more than double the number of new nursing graduates in Ghana left that country for positions abroad. In response, the Ghanaian government is now begging recruiting nations to cease taking its nurses. Economic burden. The loss of qualified nurses places considerable economic pressure on exporting African countries. In 1998 the United Nations Conference for Trade and Development estimated that every professional, ages 25–35, who migrated from South Africa represented an annual loss of $184,000 for that country. Receiving countries obtain the financial benefit of the migrant’s professional education and training, while sending countries bear these costs. The loss of valuable workers has been so costly that the South African Nursing Council has proposed an export tariff on nurses leaving to work abroad. Nurses’ Technical And Cultural Competence A key concern related to foreign nurses is whether they provide high-quality services to U.S. patients. Rosemary Stevens has argued that when discussing quality in an international context, one must distinguish between people’s ability to perform specific tasks and their ability to communicate effectively with patients and other professionals to provide culturally appropriate care. The Commission on Graduates of Foreign Nursing Schools (CGFNS) was established in 1977 to ensure foreign nurses’ technical and cultural competence prior to employment in U.S. health care institutions. Modeled after the Educational Commission for Foreign Medical Graduates (ECFMG), CGFNS verifies foreign nurses’ credentials and educational qualifications and identifies those at risk for failing the U.S. nurse licensure exam (NCLEX-RN) prior to immigration. A qualifying examination that assesses nursing proficiency and English language comprehension earns nurses a CGFNS certificate and eligibility for nonimmigrant occupational preference visas. Foreign nurses must supply evidence that they completed prescribed amounts of didactic and clinical instruction as “first-level nurses.” Defined by the International Council of Nurses (ICN), this is a measure of technical competence regardless of national background. The final step in the process is passing the NCLEX-RN. Passing nurse licensing and English proficiency tests remains the marker for establishing competence among foreign nurses. No studies to date have determined whether foreign nurses’ cultural orientation and technical competence produce differences in patient outcomes when compared with their domestic counterparts. Crisis And Opportunity In April 2002 the Workforce Commission for Hospitals and Health Systems, convened by the American Hospital Association (AHA), issued its recommendations to health care leaders for confronting the current nurse shortage and averting the predicted shortfall. Flexible staffing options and improved working conditions, methods to simplify work and improve nurses’ quality of life, and fostering more meaningful work were prominent among the strategies offered. The AHA has also advocated for federal legislative initiatives that are targeted at building and maintaining the U.S. nursing workforce. These responses have yet to dampen the strong demand for foreign nurse labor. Hospitals and nursing homes are independently recruiting nurses overseas as well as hiring recruitment agencies to secure nurses on their behalf. Because of the profitability of this latter strategy, new recruitment agencies are cropping up both within the United States and in other recruiting countries. Many U.S.-based agencies also have offices in sending countries to facilitate the process. The agencies. In recent years recruitment agencies have been placing foreign nurses in larger numbers in states that attracted both large and small numbers of nurses in the past. In 1992 California and New York were home to nearly half of all foreign nurses in the United States. By 2000 their shares of foreign nurses had declined to 38 percent, while the combined shares of the next most frequent locations—Florida, Illinois, Michigan, New Jersey, and Texas—rose to equal them. More than half of the remaining states saw increases in their shares of foreign nurses. Venkat Neni’s Global Healthcare Recruiters provides a good example of the marketing allure of foreign nurses in states that previously did not typically recruit or employ international nurses. A physician in India before immigrating to the United States, Neni founded his Wisconsin-based agency in 2002. In less than a year he successfully supplied 145 nurses from India to Milwaukee’s Columbia St. Mary’s and Oshkosh’s Mercy Medical Center. In November 2002 he and executives from Covenant Healthcare System in Milwaukee traveled to India and hired another 100 nurses. In an interview with the Milwaukee Journal Sentinel, Neni shared his goal to recruit an additional 500 nurses to Wisconsin by 2004, estimating profits to exceed $5 million. Neni’s earnings pale in comparison with those of more established firms. On average, hospitals pay recruiting agencies $5,000–$10,000 per nurse. In return, nurses contract to work from two to three years in the hiring institution. In the Covenant Healthcare System example, Global Healthcare agreed to fully refund the recruiting fee to the hospital if a nurse recruit failed to continue working past three months. The hospital was partially repaid if nurses fell short of their three-year commitment. The hiring facilities. Although hospitals agree that the initial cost of recruiting foreign nurses is higher than that of hiring domestic nurses, many feel that they save money in the long run because of reduced turnover and the agency’s assurance of full or partial remuneration if recruited nurses fail their contractual obligations. Recruiting abroad may also be less costly than raising salaries, increasing benefits, and providing other economic incentives needed to retain domestic nurses. Under the terms and conditions of hiring foreign nurses from recruiting agencies, therefore, hospitals enter into a relatively risk-free arrangement that provides further incentive for procuring staff abroad. Strategies for such recruitment at one facility are described in a 2003 AHA report on workplace innovations. The advantages of recruiting foreign nurses have had particular appeal for long-term care facilities. Since 1989 nursing homes have secured foreign nurses through an “attestation” process stipulated in the Immigration Nursing Relief Act (INRA). In recent years recruitment agencies have capitalized on the crisis in long-term care staffing, partnering with nursing home operators to provide nurses from several countries. Long-term care institutions will likely continue to look abroad to fill nearly 14,000 staff RN and 25,100 licensed practical nurse (LPN) vacancies. Implications For The Future The current U.S. nurse shortage and the profitability in recruiting foreign nurses to fill nurse vacancies will undoubtedly increase the interest in, and pressure for, additional means to increase foreign nurse recruitment.Changes in immigration policy, recruitment practices, and licensure requirements will also permit a greater flow of foreign nurses to U.S. health care facilities. For example, the cost of immigration, initially shouldered by migrating nurses, is now transferred to the facilities themselves. The NCLEX-RN examination is being offered overseas, beginning in 2004, in an effort to facilitate the licensure process. Recruitment agencies are now routinely based in the Philippines, India, and other key locations to aid nurses’ access to information, English language classes, and exam preparation courses. Newer recruitment strategies now offer U.S.-based master’s-level education to foreign nurses as a further incentive for migration. A recent San Francisco Chronicle article reported that as many as 3,000 physicians in the Philippines had begun training to become nurses for export to the United States because of the much higher salaries they could earn. Although foreign-trained nurses now account for around 5 percent of the total U.S. nursing workforce, they represent a growing percentage of newly licensed nurses. Moreover, growth in the domestic production of nurses since 2002 did not diminish interest in foreign recruitment among employers. Indeed, Peter Buerhaus and his colleagues note sizable growth in the number of foreign-born nurses in the United States during this period. And while interest in foreign nurses accelerates during nurse shortages, it also appears to endure beyond shortage cycles. In 1988, during the last major U.S. nurse shortage, there were 3.7 foreign-trained nurses in the United States per 100 U.S.-trained nurses. In 1996, a time of record domestic nurse production and a slowdown in hospitals’ demand for nurses because of industrywide workforce restructuring, the ratio rose to 5.1. Consequently, if nurse vacancies continue in health care facilities, and domestic production falls short of the demand, then foreign nurses are likely to remain a viable and increasingly lucrative strategy for plugging holes in the U.S. nurse workforce. Ethics of recruiting. Increased international recruitment requires that several policy issues be explicitly addressed. The international debate over the responsibilities of recruiting nations toward countries whose nurses are being recruited, many of which are developing countries, has produced a range of proposals—from ethical recruitment guidelines and codes of practice to financial compensation for sending countries. The British National Health Service and the ICN, for example, have both issued ethical guidelines for foreign nurse recruitment. Others have voiced concern about the long-term viability and ethics of foreign nurse recruitment in the face of a global nurse shortage. To date, the ethical guidelines have had only a modest short-term impact on recruiting practices, and the compensation proposals continue to be debated without resolution. If the United States maintains its role as a major nurse recruiter, then it should join this international dialogue. This dialogue should not be focused solely on recruitment practices but should place equal emphasis on strategies to reform work environments to improve nurse retention and reduce avoidable demand. Quality issues. Little is known about whether the quality of nursing care differs between foreign- and U.S.-trained nurses. While the certification process assures competency in educational training and language, differential quality of clinical care has not been assessed. Quality of care could be affected by, among other things, poor orientation and training of new foreign nurses who are assimilating into the U.S. health care system. The development and evaluation of more comprehensive orientation and training activities are warranted and have been recommended by the AHA. An assessment of the quality of care and patient outcomes is likewise needed and should include an appraisal of the cultural competence foreign nurses bring to patient care. Workforce strategy issues. Finally, U.S. workforce planning efforts require the development of systems that monitor the inflow of foreign nurses, their countries of origin, the settings where they work, and their impact on the nurse shortage. Increasing demand for foreign nurses in the face of greater domestic production is a signal that domestic efforts are insufficient to keep up with demand. A broader-based workforce strategy that balances foreign nurse recruitment, domestic production, and concerted retention efforts is needed to ensure that the nursing care needs of the public will be met. ___________________________________________What has existed overseas is what neo-liberals and neo-cons are now trying to do in the US. The people who get into the best universities in China or India are the children from wealthy families and these are the graduates coming to the US. They are successful enterpreneurs in the US because they made money often by the same techniques that US corporations are using today-----fleecing and winning at any cost. THIS IS A GENERALIZATION AND DOES NOT MEAN ALL IMMIGRANTS COMING WITH THIS 'EXECUTIVE ORDER' WILL BRING MORE OF WHAT THE AMERICAN PEOPLE ARE TRYING TO BE RID. IT MEANS THAT THIS POLICY SETS INTO MOTION THE PROCESS OF TOP BUSINESS LEADERSHIP COMING FROM THE RICH ONLY.

What makes this policy bad is that at the same time the American people are seeing all their pathways to higher education closing and tracking to career colleges and lost financial aid to strong 4 year universities all means 90% of Americans will not access the education, the funding, and opportunities to climb the economic ladder. I spoke of how Ivy League universities getting hundreds of billions of dollars in research building funds are now operating pipelines for students attending these universities into these global corporate jobs, totally by-passing the general population. The world's top talent taken from their own country leaves that country without benefit of those people. It will create competition and stresses between nations that are not needed.So, the Wall Street operation that makes the 1% richer is now extending to who gets the jobs in the US.

Taking Action to Attract the World’s Top Talented Professionals Secretary Penny PritzkerMay 06, 2014 11:44 AM EDT The Obama Administration announced new steps to make it easier for highly skilled workers and talented researchers from other countries to contribute to our economy and ultimately become Americans. These measures are part of administrative reforms first announced in 2012, and reflect our commitment to attracting and retaining highly-skilled immigrants, continuing our economic recovery, and encouraging job creation. Specifically, the Department of Homeland Security (DHS) published a proposed rule that would—for the first time—allow work authorization for the spouses of H-1B workers who have begun the process of applying for a green card through their employers. Once enacted, this proposed rule would empower these spouses to put their own education and skills to work for the country that they and their families now call home. This rule change was requested in a “We the People” petition to the White House. At the same time, DHS is also proposing another new rule to make it easier for outstanding professors and researchers in other countries to demonstrate their eligibility for the EB-1 visa, a type of green card reserved for the world’s best and brightest. Just as great athletes and performers are already able to provide a range of evidence to support their petition for an EB-1, professors and researchers would be able to present diverse achievements such as groundbreaking patents or prestigious scientific grants. These measures build on continuing Administration efforts to streamline existing systems, eliminate inefficiency, and increase transparency, such as by the launch of Entrepreneur Pathways, an online resource center that gives immigrant entrepreneurs an intuitive way to navigate opportunities to start and grow a business in the United States. These actions promise to unleash more of the extraordinary contributions that immigrants have always made to America’s economy. By some estimates, immigration was responsible for one-third of the explosive growth in patenting in past decades, and these innovations contributed to increasing U.S. GDP by 2.4 percent. Immigrants represent 50 percent of PhDs working in math and computer science and 57 percent of PhDs working in engineering, and one study found that 26 percent of all U.S.-based Nobel laureates over the past 50 years were foreign born. Immigrants are also overrepresented in the ranks of America’s entrepreneurs, as they are more than twice as likely as the native-born to start a business in the United States. Immigrants started one of every four small businesses and high-tech startups across America, and more than 40 percent of Fortune 500 companies—from GE and Ford to Google and Yahoo!—were founded by immigrants or the children of immigrants. While today’s executive actions are an important step in the right direction, only Congress can offer permanent solutions to fix our broken immigration system and ensure that immigration pathways for foreign entrepreneurs and talented workers are clear and consistent, and better reflect today's business realities. Last June, the Senate passed a bipartisan immigration reform bill that would significantly grow our economy and shrink the deficit. It is imperative that the House of Representatives do its part to send a bill to the President’s desk, as the costs of inaction are considerable. Among the many other benefits of commonsense immigrant reform, we need legislation that will keep talented scientists, engineers, and entrepreneurs here in America instead of compelling them to go back home and compete against us. When President Obama and I met last month with the new Presidential Ambassadors for Global Entrepreneurship, these top entrepreneurs spoke passionately about the contributions of immigrants and the importance of immigration reform for growing our economy. This group of successful American businesspeople who have committed to sharing their expertise to help develop the next generation of entrepreneurs at home and abroad agreed that we undermine our economic competitiveness when we make it harder, not easier, for talented immigrants to stay here and contribute to our economy. You can watch the video featuring inaugural Presidential Ambassadors for Global Entrepreneurship below, or on YouTube:

_______________________________________﻿﻿﻿﻿When the European Union was formed borders opened and immigration soared. People were fine with it until this decade of massive corporate fraud, deliberate economic stagnation, the TROIKA attack on Rule of Law and people's assets. Now, Europeans are mad as heck over the Trans Atlantic Trade Pact just as we are with TPP. It sells national sovereignty to global corporations.

Now, people that would never be anti-immigrant are because of these policies. The most progressive European nations are calling this Fascism. My point is that this is where the US will be with these neo-liberal/neo-con market-based Immigration Reforms. It will not help US immigrants---it will harm them. So, if you support the right of immigrant families you need to be fighting for equal protection in the workplace and CITIZENSHIP NOW!

EU Elections: Anti-Immigrant Wave Sweeps Europe

By IBTimes UK on May 26 2014 5:48 AM File photo of a huge euro sculpture in front of the headquarters of the European Central Bank (ECB) in Frankfurt, Jan. 1, 2002. Reuters The far-right National Front has topped polls in France as countries across Europe have turned to extremist and anti-EU parties.﻿The National Front led by Marine Le Pen has taken its largest share of the vote in its 40-year history with 25 percent of the votes, according to pollsters. The anti-immigration party has pledged to drastically cut immigration and reduce the influence of Islam. President Hollande's Socialist Party has been edged out into third place garnering just 13 percent of the vote. At a triumphant press conference, Le Pen, who took over the party founded by her controversial father, Jean Marie Le Pen, heralded a victory and said "the sovereign people of France have spoken loud and clear." She called on the French president to dissolve the country's government and call elections. "The people have taken back the reins of their own destiny,' she said."This means policies of the French, for the French, by the French. They do not want to be ruled from outside." Le Pen claims that the party today is removed from its racist and anti-Semitic roots with which it was synonymous under her father's leadership. The results have sent shockwaves throughout Europe heightening concerns that right-wing groups in the UK might similarly have received a boost in votes. French Prime Minister Manuel Valls said the National Front victory was "a political earthquake in France," while ecology minister Segolene Royale said: "It's a shock on a global scale." A report by Open Europe said: "Across Europe, all eyes are on the possible surge in anti-EU, populist, anti-immigrant or anti-establishment parties."There have been a number of successes for far-right and anti-EU parties across Europe, with early indications that a neo-Nazi candidate for the NPD party could be elected in Germany, giving the far-right a foothold for the first time in decades. In Greece, the anti-Europe Syriza party topped polls with about 27 percent of the vote and the extreme-right Golden Dawn party looked set to enter the European parliament for the first time, with three seats and about 9 percent of the vote. The party was Greece's third-most popular party and looked set to send three MEPs to Brussels. The extremist anti-Islam Danish People's Party also came first in that country's elections. In Italy, the Euroskeptic Five Star movement was tipped to come second. A surge in Euroskepticism across the continent led to an increased vote for protest parties -- mirroring the increased presence by UKIP in Britain. The National Front's vote was a full 11 percent higher than the ruling Socialists. In Sweden, the ant-fascist feminists won their first seat with the party placing in opposition to EU right-wing movements with the slogan, "Replace the racists with feminists!" No country was allowed to declare its results until the last polling booth closed across the continent -- in Italy at 11 p.m. and at 10 p.m., both local times.